SOCIAL NETWORKS AND PATTERNS OF USE AMONG THE POOR WITH MENTAL-HEALTHPROBLEMS IN PUERTO-RICO

OBJECTIVES. This study uses the recently developed Network-Episode Mod el (NEM) to examine the nature and correlates of utilization among Pue rto Ricans reporting mental health problems. The NEM highlights two is sues: (1) examining the patterns or combinations of lay and formal use that individuals employ and (2) reformulating how the availability an d content of social networks influences patterns of care. METHODS. Usi ng data from the 1989 Mental Health Care Utilization Among Puerto Rica ns Study (probability sample of 1,777 individuals living in low-income areas of the island), the authors focus on the patterns and correlate s of use for 365 Puerto Ricans reporting service use for mental health problems in the previous year. RESULTS. A combination of clustering a nd multinomial legit techniques indicates that there are six unique ca re patterns. Two patterns include the use of mental health providers a nd are associated with different contingencies. CONCLUSIONS. In genera l, patterns of use are shaped by age, education, gender, and illness s everity. Larger, more supportive networks decrease the use of patterns of care that include formal health care providers, and decrease direc t entry into the mental health sector. These results are in line with NEM's predictions for lower class populations and help clarify inconsi stencies in previous research on social networks. The implications of this perspective for health services research and treatment are discus sed.